[Major rural accident: the pesticide "rain" case in Lucas do Rio Verde city - MT]. / Acidente rural ampliado: o caso das "chuvas" de agrotóxicos sobre a cidade de Lucas do Rio Verde - MT.

The article reports the environmental accident caused by aerial pesticide spraying that reached the urban space of Lucas do Rio Verde-MT, in March 2006. It was characterized as a "major rural accident" of environmental and occupational aspects whose seriousness and extension crossed the agriculturally productive unit boundaries causing sanitary, social and environmental impact. This case study had as its objective the understanding of the social-technical scene of the accident and the monitoring process in health-environment in a research-action dynamic. The information was collected through interviews, documents and daily observation reports. It also referred to accidents, multidisciplinary and participatory analyses with the participation of local institutions of health, agriculture and environment, political and union leaderships, ranchers and farmers, the public prosecutor's office, journalists and the University. The study shows that the pesticide "use and abuse" monitoring actions have been extended to [a] "movement for the sustainable development of the region" supported by the participative monitoring and the fight for democracy and social justice in the search of a sustainable agriculture and/or environment.

Acidente rural ampliado: o caso das "chuvas" de agrotóxicos sobre a cidade de Lucas do Rio Verde - MT / Major rural accident: the pesticide

O artigo aborda o acidente ambiental causado por derivas de pulverizações aéreas de agrotóxico que atingiram o espaço urbano de Lucas do Rio Verde-MT, em março de 2006. Caracterizou-se como "acidente rural ampliado" de caráter ocupacional e ambiental, cuja gravidade e extensão ultrapassaram a unidade produtiva rural, causando impactos sanitários, sociais e ambientais. Este estudo de caso objetivou conhecer o cenário sociotécnico do acidente e o processo de vigilância em saúde-ambiente, numa dinâmica de pesquisa-ação. As informações foram colhidas através de entrevistas, documentos e registro de observações do cotidiano. Referenciou-se ainda na análise interdisciplinar e participativa de acidentes, com envolvimento de instituições locais de Saúde, Agricultura e Ambiente, lideranças sindicais e políticas, chacareiros e fazendeiros, Promotoria de Justiça, jornalistas e a Universidade. O estudo mostra que as ações de vigilância do "uso e abuso" de agrotóxicos ampliaram-se para "movimento pelo desenvolvimento sustentável da região", apoiado na vigilância participativa, articulada com a luta pela democracia e justiça social, na busca de uma agricultura e/ou ambiente sustentável.

The article reports the environmental accident caused by aerial pesticide spraying that reached the urban space of Lucas do Rio Verde-MT, in March 2006. It was characterized as a "major rural accident" of environmental and occupational aspects whose seriousness and extension crossed the agriculturally productive unit boundaries causing sanitary, social and environmental impact. This case study had as its objective the understanding of the social-technical scene of the accident and the monitoring process in health-environment in a research-action dynamic. The information was collected through interviews, documents and daily observation reports. It also referred to accidents, multidisciplinary and participatory analyses with the participation of local institutions of health, agriculture and environment, political and union leaderships, ranchers and farmers, the public prosecutor's office, journalists and the University. The study shows that the pesticide "use and abuse" monitoring actions have been extended to [a] "movement for the sustainable development of the region" supported by the participative monitoring and the fight for democracy and social justice in the search of a sustainable agriculture and/or environment.

Afecciones quirúrgicas en el recién nacido: Nuestras estadísticas años 2002 - 2003

Las afecciones quirúrgicas en el neonato tienen una alta morbimortalidad, por la condición de recién nacido, los trastornos ocasionados por la enfermedad de base así como por la injuria provocada posteriormente por la intervención quirúrgica. Se realizó un estudio retrospectivo por la intervención quirúrgica. Se realizó un estudio retrospectivo, longitudinal de todos los neonatos a los cuales se le diagnosticó patologías quirúrgicas en el periodo comprendido entre enero de 2002 hasta diciembre de 2003 en la provincia de Pinar del Río (Cuba) con el objetivo de analizar el comportamiento diagnóstico y terapéutico de estos pacientes. En esta etapa se intervinieron quirúrgicamente 24 recién nacidos, la mayoría fueron masculinos (17), la operación se realizó con menos de 24 horas de nacido en 14 casos, las afecciones quirúrgicas más frecuentes fueron las de intestino delgado con 7 pacientes y la supervivencia fue de un 100 por cento, logrando la mejor tasa de supervivencia de los últimos años en este territorio...(AU)

Promoção da saúde e intersetorialiedade: a experiência da vigilância em saúde do trabalhador na construção de redes / Health promotion and intersectoriality: experience of occupational health surveillance in the construction of networks

O objetivo deste trabalho é sistematizar a experiência do campo da Saúde do Trabalhador diante das temáticas da promoçãoda saúde e da intersetorialidade. São apresentados os limites, possibilidades e avanços da introdução do conceito de vigilância como organizadora das ações de saúde, e a possibilidade de construção de redes institucionais a partir da definição de um objeto - no caso, a relação entre processo de trabalho e saúde, objeto da saúde do trabalhador. Essa possibilidade é caracterizada por uma vasta gama de instituições, setores governamentais e atores sociais envolvidos no campo da saúde do trabalhador. As estratégias de vigilância em saúde do trabalhador (VST) desenvolvidas têm servido para demonstrar as possibilidades e dificuldades de ações intersetoriais de promoção e prevenção. A trajetória da saúde coletiva no país - e da saúde do trabalhador em particular - possui origens históricas e conceituais paralelas às da promoção da saúde, sendo ainda necessárias uma maior reflexão crítica e capacidade de síntese resultantes das discussões conceituais e práticas de saúde no âmbito do SUS. O campo da Saúde do trabalhador, certamente, pode contribuir nesse debate, principalmente no que tange às ações intersetoriais e coletivas de promoção da saúde voltadas às estratégias de transformação dos processos e ambientes de trabalho, por meio da construção de redes sociais e institucionais que dêem suporte às ações de VST

Epidemiología y clínica de la enfermedad inflamatoria pelvica

Con el objetivo de mejorar el diagnóstico y la conducta en las pacientes portadoras de una enfermedad inflamatoria pélvica aguda se realizó una investigación retrospectiva, longitudinal y analítica que envolvió a 103 pacientes ingresadas por esta enfermedad en el Hospital Docente Gineco Obstétrico "Justo Legón Padilla" entre enero y junio de 1998. Las variables analizadas fueron: edad, antecedentes de importancia en los tres meses previos al ingreso, síntomas y signos, forma clínica, operación realizada y cifras de eritrosedimentación al ingreso y al egreso. El análisis estadístico se realizó a través del porciento, la media, la desviación estándar y el estadígrafo Z con nivel de significación de p < 0,05 (significativo) y p < 0,01 (muy significativo). Obtuvimos significación estadística en las pacientes que tuvieron un aborto previo tres meses antes del ingreso y que sus edades oscilaban entre 20 y 29 años, así como las que tenían antecedentes de colocación de DIU con edades comprendidas entre 30 y 39 años; la triada de dolor, fiebre y leucorrea se presentó en la mayoría de los pacientes, el dolor a la palpación del útero y el crecimiento de este fue el signo fundamental. La endometritis fue la forma clínica más frecuente, siendo significativa en el grupo de menos de 20 años. La revisión de cavidad fue el tratamiento quirúrgico más empleado. Los valores medios de eritrosedimentación al egreso disminuyeron en relación con el ingreso...(AU)

[Traffic accidents in a city in Southern Brazil: an evaluation of coverage and quality of data]. / Acidentes de transporte terrestre em cidade da Região Sul do Brasil: avaliação da cobertura e qualidade dos dados.

The aim of this study was to analyze police coverage and the validity of data on emergency and hospitalization records as well as on death certificates for traffic casualties in Londrina, Paraná State, Brazil. Victims (3,643) of road accidents during the first semester of 1996 were investigated and followed up after 180 days to confirm whether death was due to the accident. Police data recorded only 32.5% of the casualties, the coverage being higher for car occupants (71.6%) and lower for cyclists (8.1%) and pedestrians (24.8%). Agreement was low between original information and that derived from investigation of death certificates (Kappa coefficient 0.10; 95% CI: 0.02-0.17), fair for hospitalization records (Kappa coefficient 0.33; 95% CI: 0.27-0.40), and substantial for emergency records (Kappa coefficient 0.63; 95% CI: 0.61-0.65). Results suggest that police data underestimate the number of traffic casualties and that it is necessary to improve the validity of medical records.

[Road accidents in a city in southern Brazil]. / Acidentes de transporte terrestre em município da Região Sul do Brasil.

The study was conducted in the municipality of Londrina, a medium-sized city of southern Brazil. Analysis was performed in the characteristics of road accidents that had occurred during the first semester of 1996, resulting in 3,643 victims. Car or small truck collisions were the most common type of accident. The rate of motorcycle-related injuries (per 1,000 registered vehicles) was seven times higher than that resulting from cars or small trucks. Fatality rates were higher for motorcyclists who collided with stationary objects (29.4%) and pedestrians who were injured by lorries or buses (22.2%), in comparison with a mean fatality rate of 1.8%. This information may provide a basis for the implementation of public policies aiming at reducing accidents.

[Characteristics of the victims of traffic accidents in a city of the southern region of Brazil]. / Características das vítimas por acidentes de transporte terrestre em município da Região Sul do Brasil.

OBJECTIVE: To evaluate the magnitude of morbidity and mortality and describe some of the characteristics of road accident victims. METHODS: The study population was composed of 3,643 victims of road accidents which occurred in Londrina, PR (Brazil), during the first semester of 1996. There were included victims from accidents registered by the Military Police, those who died at the accident scenario or on their way to the hospital, those who received emergency care or were hospitalized through the Unified Care System. It was observed a period of 180 days for death verification. RESULTS: The mean incidence and mortality rates were 1,582.2 and 29. 0 per 100,000 inhabitants, respectively. These rates, however, have demonstrated great variability in relation to several characteristics (place of residence, gender, age and the victim's mode of transport). The majority of victims were motorcyclists, followed by cyclists and pedestrians who, altogether, accounted for 76.9% of the total, and 81.5% of those who died. CONCLUSIONS: These results suggest that road accidents constitute a major cause of morbidity and mortality and that specific preventive measures should be considered in order to reduce such accidents, especially those that involve the most vulnerable road passers.

Aplicabilidade do ácido trans, transmucônico urinário como indicador biológico na avaliaçäo da exposiçäo ocupacional ao benzeno / Applicability of urinary trans, trans-muconic acid as a biological indicator in evaluation of occupational exposure to benzene

Na busca de um indicador biológico efetivo para estudo da exposição ao benzeno, em substituição ao fenol urinário, o ácido trans, trans-mucônico (ttAM) tem sido apresentado como excelente alternativa. Para comprovar este fato, este estudo foi realizado em trabalhadores expostos à baixas concentrações ambientais de benzeno. O grupo de estudo foi constituído por 36 frentistas e 37 mecânicos de automóveis o grupo de controle, por 50 trabalhadores de um edifício de escritórios. Entre os mecânicos, valores (média geométrica) de 0,43 ppm (0,08-0,90 ppm) de benzeno no ar e 1,05 mg/g creatinina (0,34-2,10 mg/g creatina) de ttAM foram encontrados. Entre os frentistas estes valores foram 0,31 ppm (0,04-0,70 ppm) e 0,97 mg/g creatina (0,2-2,0 mg/g creatina) respectivamente. A correlação observada: r = 0,88 (p<0,001); y =0,7076x + 0,3134, r2 = 0,78 sugere que o ttAM é um bom parâmetro para estimar a exposição de benzeno mesmo a baixas concentrações ambientais.

[Morbidity and mortality due to traumatic brain injury in São Paulo City, Brazil, 1997]. / Morbimortalidade por traumatismo crânio-encefálico no município de São Paulo, 1997.

There are few epidemiological studies on traumatic brain injury (TBI), and those that allow broad comparative analyses of this problem are even more scarce, due to methodological obstacles. Usually, the studies address head injury (they include the cranial envelopments and content) but are reported as TBI, given the difficulty of mutual exclusion. It is also common for them to be centered at specific severity levels, only for hospitalized victims or according to the external cause, such as traffic accidents. With full respect to these limits, this study had as its objective the estimation of the TBI incidence in patients resident and in-hospital, in the hospital network in the city of São Paulo, Brazil, in 1997, as well as the estimation of TBI-caused mortality amongst external causes, at this same time and locale. Data for the study consisted of Ministério da Saúde data on hospital discharges, analyzed based on Autorizações de Internação Hospitalar (AIH) and obituary data on external causes, contained in the Programa de Aprimoramento das Informações de Mortalidade (PROAIM) data base. It was found that 29 717 patients were hospitalized due to lesions and poisoning; of these 3 635 (12%) had TBI; the hospitalization rate was 0.36/1000 pop.; and hospital mortality was 10%. The mortality coefficient due to external causes was 87.3/100 000 pop. Minimum TBI mortality rate is estimated at a minimum of 26.2 and a maximum of 39.3/100000 pop.

[Reflections on the measurement of maternal mortality]. / Reflexões sobre a mensuração da mortalidade materna.

The maternal mortality rate is a highly sensitive indicator for the health level of both women and the general population in a given geographical area. There is extensive variability among different countries, and rates are high in underdeveloped or developing areas, as in Brazil. Health authorities from various countries have launched programs aimed at reducing maternal deaths and have thus needed to estimate the actual rates to allow for a proper assessment and to control the programs' progress. However, there are many obstacles and difficulties in obtaining the real values of these measures, mainly because of incomplete data. The aim of this paper is to present some of the proposed methodologies for estimating maternal mortality rates and to call attention to the limits and biases of these methods. Based on the Brazilian case, the article also recommends an improvement in the quality and coverage of the Civil Registry, the official source of data on births and deaths.

[Mortality among children of less than one year of age in the Southwestern region of Brazil]. / Mortalidade infantil de menores de um ano de idade na região do Sudoeste do Estado de São Paulo.

OBJECTIVE: A description of infant mortality in children of less than one year of age on the basis of official systems of information. METHODS: The data were obtained from two official information systems of the Health Ministry: of mortality and live-births. Health service and home visits were carried out to complete the information on death certificates. RESULTS: Infant mortality was 49.7. It was higher among boys, low birthweight children, twin births, among those born by cesarean section, resident in the outskirts, among children of mothers of little schooling, greater number of children on above 35 years of age. The data on death certificates were poorly reported. Data on birth certificates were complete. CONCLUSION: The results suggested that a health information system should be implemented, with a view to reducing infant mortality.

[Small for gestational age: risk factor for neonatal mortality]. / Pequenos para idade gestacional: fator de risco para mortalidade neonatal.

INTRODUCTION: Variables of birth certificates were analysed as risk factors of SGA (Small for Gestational Age) infantis, and with a view to discovering if retarded intra-uterine growth was a risk factor neonatal mortality. MATERIAL AND METHOD: Data were obtained directly from 11 hospital medical records. A cohort of 2.251 hospital live births was obtained. Linkage of the death and birth certificates was undertaken to identify the neonatal deaths. The study was carried out in Santo André county in the S. Paulo Metropolitan area in the period from 1/1 to 30/6/1992. RESULTS: There were 4.3% of SGA live births. A higher statistically significant proportion of SGA was found in pre-term and post-term live births, among live births of mothers with 35 years of age and over and in those whose mothers had less than complete primary education. The SGA live births showed a higher risk of neonatal death, even when allowing for gestational age. CONCLUSIONS: In areas where there is a low proportion of low birthweight, the presence of retarded intra-uterine growth may be an important risk factor to pre-term live births, due to the association between the pre-term and SGA. It would be easier to evaluate signs of retarded intra-uterine growth in the live birth population, if the gestational age data were registered, on the birth certificate in weeks.

[Accidents and acts of violence in Brazil: I--Analysis of mortality data]. / I--análise dos dados de mortalidade.

External causes are an important cause of death in almost all countries. They are always the second or third in the mortality ranking, but their distribution according to type varies from country to country. Mortality due to external causes by type, gender and age, for Brazil as a whole and for state capitals specifically, is analysed. Mortality rates and the proportional mortality from 1977 to 1994 were calculated. The results showed that the number of deaths due to external causes has almost doubled from 1977 to 1994 and nowadays this is the second cause of death in Brazil. The mortality rate, in 1991, was 69.8 per 100,000 inhabitants and the highest increase was in the male rates. The male rates are almost 4.5 times greater than the female ones. The first cause of death among people from 5 to 39 years old is external causes, and the majority occur between 15 and 19 years of age (65% of the deaths by external causes). Besides the growth in itself it also seems that a shift of deaths to hower ages is occurring. Both mortality by traffic accidents and that by homicide have increased over the period from 1977 to 1994. Suicides have been stable and "other external causes" have increased slowly, especially due to falls and drowning. The mortality rates for external causes in state capitals are higher than the average for Brazil as a whole, except for some northeastern capitals. The rates for the capitals in the northern region are the highest in Brazil. In the northeastern region, only Recife, Maceió and Salvador have high rates. In the southeast, Vitória, Rio de Janeiro and S. Paulo have the highest rates in the country but Belo Horizonte's rates are declining. In the southern region all the capitals showed a growth in the rates as also in the capitals of the West-central region. The growth of mortality due to external causes type of external cause is different in these capitals. Suicide is not a public health problem in Brazil nor the state capitals. Traffic accidents are a major problem in Vitória, Goiânia, Macapá, the Distrito Federal and Curitiba. Homicides have increased greatly in Porto Velho, Rio Branco, Recife, S. Luís, Vitória, S. Paulo, Curitiba, Porto Alegre, Cuiabá and the Distrito Federal. The mortality due to external causes in Brazil has become a major public health problem, especially because of homicides. It is important to emphasize that the quality of the mortality data on external causes is not the same for all capitals, because it is a question very closely related to the quality of legal information.

[Accidents and acts of violence in Brazil: II--Hospital morbidity from lesions and poisonings]. / Morbidade hospitalar por lesões e envenenamentos.

Today in Brazil the "Hospital Internment Authorizations" (AIH) represents about 80% of the total internments in the country and constitutes a data base of easy access available in CD-ROM. This high coverage allows one to draw a reasonable picture, close to reality, of the morbidity demanding hospitalization. Among the causes there is the diagnostic category lesions and poisonings noteworthy for severity and frequency. Hospital internments by this diagnostic category occurring in a month in 1994 have been focused on. Some epidemiological and hospital use characteristics, such as demographic aspects, specific diagnostic category, length of stay and mortality are described. It was observed that lesions and poisonings accounted for 5% to 6% of all hospital internments in the country, being predominantly among men under 65 of age. This diagnostic category was the first cause of hospital internments among men of from 15 to 29 years of age. Fractures were the most frequent specific diagnosis (about 37.5%), almost all of them involving members (legs or arms). The injuries were mainly located in hands, arms, head and neck and occurred predominantly among young men, leading to the believe that they were due to work or traffic accidents. Regarding burns, the fragment occurrence among children under 5 years of age is worthy of note. The authors lament the lack of information as to their causes such as would enable appropriate preventive actions to be taken.

[Analysis of registries of live births in an urban area of Southern Brazil]. / Análise dos registros de nascimentos vivos em localidade urbana no Sul do Brasil.

Live births which occurred in the period from April to September of 1994 were analysed, using the two copies of the Birth Declaration-BD-(the white copy coming from the hospital where the child was born and the yellow copy sent by the Legal Registry Office where the birth was registered) received by the Londrina Municipal Health Service. After the "cross matching" of both copies (for each child), household interviews were performed in cases without matched pairs (only a white or only a yellow copy indicating possible unregistered or home deliveries). Results showed that the proportion of births not legally registered was of from 5.3 to 6.6% of the hospital births. Cost, negligence and legitimacy were the main reasons given for not registering births legally. The average time taken to make the registration was 26.5 days (standard deviation of 52 days) and 88.7% of the families did it by the 60th day from the date of the birth. A statistical association was detected between the act of registration and the period within which registration is required (within 60 days from birth) and type of delivery, maternal age and education. The official proportion of home deliveries was 0.5%; however, after the research the value was found to be somewhere between 0.13 and 0.3% of all the registered births--only 36.8% were really born at home. Reasons for home deliveries were: option, "there wasn't a means of transport to take the pregnant woman to hospital" and "there wasn't enough time to get to a hospital".

[Youth mortality: analysis of the period from 1930 to 1991 (the epidemiological transition to violence)]. / Mortalidade de jovens: análise do período de 1930 a 1991 (a transição epidemiológica para a violência).

Youth (15 to 24 years old) mortality in the cities of Rio de Janeiro and S. Paulo from 1930 to 1991 is studied. The objective is the recovery of historical data covering the period from the third decade of this century up to the present so as to evaluate mortality profile changes based on causes of death and to compare them with international indicators. Results show that S. Paulo experienced a rapid decline in the death rate for the group up to 1970, as also happened in Rio de Janeiro city up to 1980. This latter city has always shown higher mortality rates. However, during the past decade a higher proportion of deaths occurred in S. Paulo resulting in closer mortality curves. Young people's mortality rates are not no longer decreasing. The rising tendency is accounted on male mortality increase. Infectious diseases, primarily tuberculosis, were responsible for the highest rates during the first decades studied, up to the fifties. After 1960 a transition took place and violent deaths, such as accidents and homicide, became the leading causes. Besides them, depending on the period analysed, cardiovascular diseases, respiratory infection and, later on, AIDS came to occupy a prominent position.